Mylan CEO Bresch Grilled On Capitol Hill Over EpiPen Debacle

Mylan Inc. CEO Heather Bresch testifies during a hearing before the House Oversight and Government Reform Committee September 21, 2016 on Capitol Hill in Washington, D.C. (Photo by Alex Wong/Getty Images)

Also appearing before the committee was Douglas Throckmorton, deputy director of regulatory programs at the U.S. Food and Drug Administration. Throckmorton felt a little of the bipartisan flames, too, but was made of more heat-resistant stuff than Bresch, deflecting most of the queries by citing federal rules.

Committee chair Jason Chaffetz (R-Utah) opened the proceedings with an unforgiving assessment of Mylan’s behavior since acquiring the EpiPen as a product in 2007. He and other members of the committee, regardless of political affiliation, uniformly expressed their strong disapproval of Mylan’s tactics, calling them “disgusting,” “sickening” and “astounding.”

Committee member Scott DesJarlais (R-Tenn.), a medical doctor, asked Bresch if she had a “guilty conscience” about the cost bumps that have reportedly priced many families out of affording the lifesaving autoinjector pens.

“Here’s another example of a lifesaving drug that you have to have,” Chaffetz said. “If you don’t have it you’re going to die. When the juice is a dollar and they’re selling for $600, there is some room for some profit.”

Committee members hammered hard on Mylan’s price-hike timeline, asking whether or not the company had planned the price increases around the anticipated entry of generics into the market. They also latched like terriers onto Bresch’s repeated assertion of having given away the autoinjectors to tens of thousands of schools, prompting DesJarlais to ask, if they were so inexpensive that the company could just give them away to schools, “Why not sell them for $20?” in the first place.

The schools question became a sensitive one almost immediately thanks to a report from USA Today that Bresch’s mother, Gayle Manchin, had "spearheaded an unprecedented effort" to get the autoinjectors into public schools when she was president of the National Association of State Boards of Education in 2012. When asked about the report during the committee hearing, Bresch called the article inaccurate and said it was a “cheap shot” to bring her mother “into this.”

Bresch repeatedly ducked direct questions about why Mylan had raised the price and about the expected profits from offering the $300 generic. One committee member noted that these may be offered direct to consumers, which would cut out the “middleman costs” that the CEO has argued previously ate up much of the $600 consumers could shell out for a pair of the injectors.

Indeed, despite repeated questions from several committee members about these anticipated profits, the difference a $300 generic versus its identical $600 branded version will make to Mylan, which had already offered $300 “coupons” on the branded version, remains unclear.

According to Bresch's testimony, the company makes $100 off of every two-pack of autoinjectors it sells. Last year, it sold 4 million of them, she said.

Bresch acknowledged to William Lacy Clay (D-Va.) that Mylan has spent “millions and millions” to expand the EpiPen market. But as often as committee members asked about profit and marketing expenses, Bresch just as often used the word “unprecedented” in her reply. She urged, repeatedly, that Mylan’s rapid decision to roll out an authorized generic of its autoinjector was an “unprecedented” move on the company’s part. At one of these instances, committee chair Chaffetz shot back, “The increase in price was unprecedented.”

The gloves were off with Chaffetz’s opening remarks and stayed off. Clay, who confronted Bresch with a series of what he called “yes-or-no questions” that rarely elicited a single-word response from her, told the CEO that “to have companies like yours take advantage of this situation…I think it speaks to something…that we are better than that.”

Bresch repeatedly also tried to paint Mylan as having at heart only the welfare of those under threat of anaphylaxis, noting how much the company had invested in "education" and awareness about anaphylaxis and having autoinjectors on hand. But the committee members weren’t buying what she was selling.

DesJarlais, the MD, asked incredulously, “You’re doing everyone a favor? … I have a problem as a physician that you take drugs that are lifesaving drugs” and roll up prices, he added, asking, “You can sit there with a clear conscience and say that’s OK?”

Perhaps expressing the committee’s general skepticism best was Elijah E. Cummings (D-Md.), who predicted in his remarks that this appearance by Mylan’s CEO would be another pharmaceutical company “rope-a-dope” akin to what happened when Martin Shkreli appeared before the panel as former CEO of Turing Pharmaceuticals. Rope-a-dope is a tactic of bracing against the ropes in boxing and taking ineffectual blows from your opponent until they become too exhausted to continue, after which you presumably leave the ring intact.

Cummings noted to Bresch that Shkreli had taken the Fifth in his appearance in front of the panel, and, he suggested to Bresch, she would have been just as well off to have done that, too, given the little information she provided. “I don’t feel that you have been frank with us,” he told Bresch. “If I could sum up this hearing, the numbers don’t add up.”

Earlier in the hearing, Cummings said:

Mr. Shkreli when we had him before us…as soon as he got out of the hearing, he called us imbeciles. He said that because he knew that they would go back and do the same thing over and over again…he rope-a-doped… I hope when this hearing is over you don’t go back to the champagne and say, ‘We rope-a-doped it.’

Cummings continued, referencing Bresch's statement submitted to the committee before her appearance:

I did read your testimony, Ms. Bresch, and I was not impressed. They [Mylan] raised the prices, I believe, to get filthy rich at the expense of our constituents... While the price of EpiPen shot up, so did Ms. Bresch’s paycheck…

I’m concerned that this is another rope-a-dope strategy…today...the industry will take their punches…but afterwards, they’ll just come out of there and keep raising prices. After Mylan takes our punches, they’ll fly back to their mansions and their private jets and laugh all the way to the bank while our constituents suffer, file for bankruptcy, and watch their children get sicker or die.

Buddy Carter (R-Ga.) a pharmacist, brought home the reality of the high autoinjector prices at the pharmacy cash register, describing seeing a mother of a child who had had an anaphylactic episode in tears, calling family members for money, because she couldn’t afford the price of the pens.

In the process of grilling Bresch, Carter repeatedly reminded the CEO, when she failed to give a direct answer or denied knowledge of specific circumstances, that she was under oath. He ended his questioning by calling Bresch’s replies and lack of detailed information a “shell game.”

Bonnie Watson Coleman (D-N.J.) cited Bresch’s use of the company jet and other perks in addition to her "astronomical salary." When Coleman’s point became clear—she asked Bresch how much her private jet ride to DC for the hearings cost—Bresch faltered in her replies, and Coleman drew a strong distinction between the expense of a company-funded private-jet lifestyle and regular consumers having to scramble to afford a life-saving drug with minimal production expenses.

Bresch seems to have come before the committee with two talking points on offer: Mylan’s generosity in giving away the autoinjectors to schools and spending on “access and awareness” programs, and the company’s “unprecedented” decision to roll out the generic. The access and awareness, of course, are simply part of any pharmaceutical company’s “find” goals—find people who need what you’re selling and make them aware of it so that they will buy it.

Although it’s unclear what the committee can and will do next, its members clearly weren't buying Bresch’s attempts to cast Mylan as proceeding at every step out of altruism. But convincing the committee may not have been the end game here anyway.

Bresch wasn’t exactly nimble or even articulate under the questioning, but she generally kept an air of coolly riding all of this out. If she brought enough cool ultimately to dissipate the heat coming her way, maybe it was enough to achieve the possible real goal just as Cummings described it: walking out of the ring intact.

I am a journalist who focuses on science and health. Read more about me here and find me (too often) on Twitter.